=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164680476
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ST.JOSEPH'S MEDICAL CENTER PHARMACY DEPARTMENT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/23/2008
-----------------------------------------------------
Last Update Date | 05/23/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 703 MAIN ST PHARMACY DEPARTMENT BASEMENT
-----------------------------------------------------
City | PATERSON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07503-2621
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-754-3029
-----------------------------------------------------
Fax | 973-754-3695
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 703 MAIN ST PHARMACY DEPARTMENT BASEMENT
-----------------------------------------------------
City | PATERSON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07503-2621
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-754-3029
-----------------------------------------------------
Fax | 973-754-3695
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACY MANAGER
-----------------------------------------------------
Name | MICHAEL CAIROLI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 973-754-3029
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282N00000X
-----------------------------------------------------
Taxonomy Name | General Acute Care Hospital
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------